March, 1949 P H Y S I O T H E R A P Y Page Three Editorial T h e E ditor does not hold h im self responsible for the view s expressed by contributors. A N N U A L C O N F E R E N C E N o ti ce is d r a w n to t h e f a c t th a t t h e A n n u a l C o n ­ f e r e n c e will be he ld in J o h a n n e s b u r g o n 2 1 - 2 2 M a y , 10JO N o w is t h e o p p o r t u n i t y f o r t h o s e w h o f e e l th at t h e S o c i e t y r e q u i r e s s h a k i n g up to o f f e r s u g g e s t i o n s to h o w e x a c t l y this c ou ld b e s t b e a c c o m p li s h e d . A l l '^ou h a v e to do is to b r i n g y o u r v a r i o u s i d e a s up f o r di scu ssion at B r a n c h m e e t i n g s . S h o u l d th e B r a n c h pro ve, y o u r s u g g e s t i o n s m a y be i n c o r p o r a t e d in the official r e s o lu t io n s to b e d i s c u s s e d b y C o n f e r e n c e . A point to r e m e m b e r , h o w e v e r , is t h a t if y o u a r e re al ly k e e n a b o u t v e n t i l a t i n g g r i e v a n c e s o r o f f e r i n g sug g es tio n s, y o u o u g h t al so to h a v e s uf fic ie nt c o u r a g e of y o u r c o n v i c t i o n s to a s s i s t w i t h th e ir i m p l e m e n t a t i o n . 1 ike yon, the p r e s e n t E d i t o r w a s , a n d f o r th a t m a t t e r still is, a d i s g r u n t l e d ty p e . C o n f o r m i n g to th e rule s o f the gam e, y o u r C e n t r a l E x e c u t i v e C o m m i t t e e at once too k a d v a n t a g e o f th is f a c t to i n s t a l h i m in a position w h e r e he c ou ld c o n t i n u e hi s g r u m b l i n g activities. T h e d i f f e r e n c e is t h a t h e n o w g r u m b l e s 011 b e h a l f of, a n d no t ab o u t th e S o c i e t y . D I R E C T O R Y O F M E M B E R S T h e 1949 ed i t io n h a s r e c e n t l y b e e n p u b li s h e d an d is in the c o u r s e o f b e i n g d i s t r i b u t e d to B r a n c h s e c r e t a r i e s . I t wil l be o b s e r v e d th a t v a r i o u s n e w b r a n c h e s h a v e b e e n inc lude d. F o r th e c o n v e n i e n c e o f m e m b e r s s e p a r a t e a l p h a ­ b e ti c a l li sts o f m a l e an d f e m a l e p h y s i o t h e r a p i s t s h a v e b e e n i ncl ude d. I t w a s h o p e d to i n d i c a t e w h ic h m e m b e r s w e r e in p r i v a t e p r a c t i c e bu t th is i n f o r m a t i o n w a s n o t a v a i la b le . T h i s i n n o v a t i o n w i ll b e i n t r o d u c e d n e x t y e a r . T H E A M E R I C A N P H Y S I C A L T H E R A P Y R E V I E W T h r o u g h th e k i n d n e s s o f t h e E x e c u t i v e S e c r e t a r y o f th e A m e r i c a n P h y s i c a l T h e r a p y A s s o c i a t i o n , w c h a v e r e c e i v e d the fi r s t o f w h a t w e h o p e wil l b e a r e g u l a r s u p p l y o f th is R e v i e w . I t is a w e ll p r i n t e d a n d c o m p a c t p u b li c a t i o n w h i c h d e a ls c o m p r e h e n s i v e l y w i t h th e a c t i v i t i e s o f o u r f e l l o w m e m b e r s in the U n i t e d S t a t e s . U n t i l p e r m i s s i o n is o b t a i n e d to r e p r i n t f r o m the R e v i e w , r e a d e r s wil l b e u n a b l e to r e a d a b o u t all th a t is b e i n g d o n e in t h a t c o u n t r y . P h y s i c a l t h e r a p i s t s t h er e, h o w e v e r , a p p e a r to be b r i n g i n g t h e m s e lv e s , an d t h e i r p r o f e s s i o n , m o r e to the n o t ic e o f th e m e d i c a l p r o f e s s i o n t h a n lias h i t h e r t o b e e n th e c as e . A preliminary report on the treatm ent and suggested E tio lo g y o f m uscle spasm in poliom yelitis by Jos. Lannon, F.R.C.S., and D r . Jos. L . Braudo, M .B ., C h .B ., appears on page 11. C om m en t b y the E ditor on this report is published below, and furth er view s o f physiotherapists will be w elcom ed. A s a re su lt o f o b s e r v a t i o n s m a d e d u r i n g th e 1945 and 1948 e p i d e m ic s w h i c h o c c u r r e d in S o u t h A f r i c a , Mr. J o s . L a n n o n , a J o h a n n e s b u r g s u r g e o n , ha s recorded s o m e i n t e r e s t i n g po i n t s r e g a r d i n g th e e t i o ­ logy and t r e a t m e n t o f m u s c l e s p a s m in p o li o m y e l it is . T h e s e he h a s i n c o r p o r a t e d in a p r e l i m i n a r y r e p o r t which w a s p u b li s h e d r e c e n t l y in the S . A . M . J . and is now r e p r in t e d o n p a g e 1 1 . L a n n o n pu ts f o r w a r d a p h y s i o l o g i c a l c o n c e p t o f the et i o lo g y o f t h e s p a s m w h i c h o c c u r s in th e e a r l y stages o f the d i s e a s e , a n d s u g g e s t s th at it is r e la t e d to lesions in t h e s y m p a t h e t i c g a n g l i a . T h e lesion results in s y m p a t h e t i c o v e r a c t i v i t y . T h i s , in turn, leads to a c o n d i t i o n o f h e i g h t e n e d m u s c l e to n e o r spasm. — His c o n c e p t d i f f e r s f r o m t h a t o f T o o m e y a n d o t h e r authorities w i t h r e g a r d to the m e c h a n i s m o f s p as m . The latter, w h o s e v i e w s h a v e so f a r b e e n u n i v e r s a l l y accepted, r e g a r d s s p a s m a s a s e c o n d a r y m a n i f e s t a t i o n which o cc u rs a s a r e f l e x to n ic c o n t r a c t i o n in a n t a g o ­ nists w h e n s p a s m ha s d e v e lo p e d in th e a g o n i s t s . Samson W r i g h t s t a t e s t h a t s y m p a t h e t i c i n n e r v a t i o n 1S in no w a y r e s p o n s i b l e f o r th e m a i n t e n a n c e o f muscle tone. S e c t i o n o f the s y m p a t h e t i c s u p p l y to a limb wh ich is s p a s t i c a s a r e s u lt o f a p y r a m i d a l lesion does not m o d i f y th e d e g r e e o f h y p e r t o n u s which is p r e s e n t . H e ad ds, h o w e v e r , t h a t s e c o n d a r y changes m a y d e v e lo p in th e m u s c l e s o w i n g to a l t e r a ­ tion in the ir b lo o d s up pl y . E v e n m o r e e m p h a t i c a l l y le goes on to s t a t e th a t it is c e r t a i n t h a t m u s c l e tone d ep en d s o n a p r o p r i o c e p t i v e r e f l e x a r c w h ic h involves the som atic nervous system alone. In A u s t r a l i a , H u n t e r an d R o y l e c la i m e d s u c c e s s in s p a s t i c c o n d i t i o n s t h r o u g h s y m p a t h e c t o m y . T h e i r w o r k w a s d e m o n s t r a t e d in E n g l a n d , b u t a t t e m p t s b y o t h e r s to s u b s t a n t i a t e th e ir c l a i m s p r o v e d o f no v a l u e an d t h e i r c la i m s w e r e not a c c e p te d . D e s p i t e th e f a c t t h a t e t a m o n n o r m a l l y a c ts in a m a n n e r c a l c u l a t e d to c a u s e a t e m p o r a r y b l o c k a g e in th e t r a n s m i s s i o n o f i m p u ls e s t h r o u g h th e a u t o n o m i c g a n g l i a , it is felt th a t t h e r e m u s t be s o m e o t h e r m e c h a n i s m t h r o u g h w h i c h t h e d r u g r e l i e v e s th e s p a s m o f s t r i a t e d m u s c l e in p o li o m y e l it is . W h e n the a u t h o r g e t s a w a y f r o m t h e o r y a n d q u o t e s th e r e s u l t s o f e t a m o n t h e r a p y , s e v e r a l o f his s t a t e - m e i t s r e q u i r e f u r t h e r el u c id a ti o n . Fo r . e x a m p l e , he r e p o r t s th e d r a m a t i c d i s a p p e a r a n c e o f f o u r e q u i n o - v a r u s d e f o r m i t i e s i m m e d i a t e l y a f t e r e t a m o n . I n tw o o t h e r c a s e s w i t h fl e x i o n d e f o r m i t i e s o f t h e w r i s t an d f i n g e r s w i t h m a r k e d a d d u c t io n at th e s h o u l d e r jo in t, “ c o m p l e t e r e t u r n o f f u n c t i o n ” is c l a i m e d s o o n a f t e r tr e a t m e n t . I11 n e i t h e r o f th e c a s e s q u o t e d is t h e r e a n y e v i d e n c e o f a f o l l o w - u p h a v i n g b e e n c a r r i e d out , n o r is t h e r e a n y s pe c ifi c m e n t i o n o f p a r a l y s e d m u s c l e s . In th e l a t t e r tw o c a s e s , h o w e v e r , i f th e e x p r e s s i o n “ c o m p l e t e r e t u r n o f f u n c t i o n ” is t a k e n a t f a c e v al u e, it c a n o n l y be a s s u m e d th a t it a p p l i e s to b o th th e s p a s t i c a n d th e t e m p o r a r i l y p a r a l y s e d m u s c l e s . L a n n o n t h e n g o e s o n to s t a t e t h a t an i m p o r t a n t f e a t u r e in s o m e c a s e s w a s th e r e s t o r a t i o n o f f u n c t i o n in m u s c l e s w h i c h h i t h e r t o w e r e r e g a r d e d a s “ p a r a ­ l y s e d , ” a n d a d d s t h a t th is w a s d u e to t h e f a c t th a t R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Page Four P H Y S I O T H E R A P Y March, 1949 m u s c u l a r p o w e r w a s d i s g u is e d b y th e e x i s t i n g s p a s m in th e m u s c l e s t h e m s e l v e s o r in t h e i r a n t a g o n i s t s . M o s t a u t h o r i t i e s on p o li o m y e l it is r e g a r d the r e s t o r a ­ tion o f f u n c t i o n w h i c h o c c u r s in s o m e o f the o r i g i n ­ a l l y a f f e c t e d m u s c l e s a s a p e r f e c t l y n o r m a l p h e n o ­ m en on . A k n o w l e d g e o f th e p a t h o l o g y o f the d i s e a s e en a b le s o n e to u n d e r s t a n d j u s t w h y this r e c o v e r y sh ou ld t a k e p l a c e s p o n t a n e o u s l y in s o m e c a se s. A c c o r d i n g to S i r J a s . P n r v e s - S t e w a r t , in th e 3 r d o r p a r a l y t i c s t a g e t h e r e is h y p e r a e m i a a n d p e r i ­ v a s c u l a r i n fi lt r a ti o n , e s p e c i a l l y o f th e a n t e r i o r ho rn s , fo r w h i c h th e v i r u s h a s a sp e c ia l af fi n i ty . T h e a n t e r i o r c o r n u a l c e ll s b e c o m e o e d e m a t o u s a n d i n a c t i v e and, if d e g e n e r a t i o n o f t h e s e c el ls s u p e r v e n e s , th e c o r r e s ­ p o n d i n g m u s c l e s u n d e r g o p e r m a n e n t p a r a l y s i s and a t r o p h y . W i t h r e f e r e n c e to this, C h o l m l e y o b s e r v e s | th a t o n l y c e r t a i n o f the a n t e r i o r h o r n c e lls w i ll be d e s t r o y e d , b u t o w i n g to th e o e d e m a in th e a f f e c t e d ! a r e a , n e i g h b o u r i n g n e r v e c el ls m a y b e t e m p o r a r i l y put o ut o f a c t i o n an d 011 this ac c o u n t , th e a c u te p a r a l y s i s m a y b e m o r e e x t e n s i v e th a n th e final ■ pi ct ure , even w ithout treatm ent. M e n n e l l is e v e n m o r e defin ite . H e s t a t e s t h a t it is a w e ll k n o w n f a c t th at , h o w e v e r , c o m p l e t e th e p a r a ­ ly s i s m a j r s e e m a t fir st, s o m e r e t u r n o f p o w e r at a f a i r l y e a r l y d a t e is u s u a l l y to be e x p e c t e d . I n o t h e r w o r d s , s o m e o f th e f i b r e s a r e p a r a l y s e d , n o t b y d i s e a s e o f the n e r v e c el ls to w h i c h t h e y o w e t h e i r i n n e r ­ v at io n, bu t b e c a u s e t h e s e c el ls a r e in c lo s e p r o x i m i t y to o t h e r s w h i c h h a v e s u f f e r e d . U n l e s s th e u tm o s t c a r e a n d a t t e n t i o n is p a id to th e s e c a s e s , n o t o n l y do t h e s e m u s c l e fi b r e s fa il to r e c o v e r w h o s e n e r v e s u p p l y is d e s t r o y e d , but al so th o s e f i b r e s w h o s e n e r v e c el ls w e r e t e m p o r a r y a f fe c t e d . In the li gh t o f t h e s e v i e w s , it s e e m s r e a s o n a b l e to a s s u m e th at i n . t h e c a s e s q u o t e d b y L a n n o n , s p a s m d e v e l o p e d in the a n t a g o n i s t s d u r i n g th e p e r i o d w h e n th e a g o n i s t s w e r e still p a r a l y s e d b j ' the p r e s s u r e on th ei r a n t e r i o r ho rn ce lls. On e t a m o n b e i n g a d m i n i s t e r e d , this s p a s m d i s a p p e a r e d an d th e r e t u r n o f m u s c u l a r p o w e r b e c a m e a p p a r e n t . W i t h r e f e r e n c e to L a n n o n ’ s o b s e r v a t i o n th a t s p a s m in the m u s c l e s t h e m s e l v e s m a y h a v e d i s g u is e d the r e t u r n o f m u s c u l a r p o w e r , this is a v e r y m o o t point. D e s p i t e a c e r t a i n a m o u n t o f c r e d e n c e b e i n g a c c o r d e d to S i s t e r K e n n y ’s a s s e r t i o n s to this ef f e c t , h e r c la i m s h a v e n e v e r r e c e i v e d th e u n q u a li fi e d s u p p o r t o f the m ed ic a l p r o f e s s i o n as a w h o l e. I n co n cl u s i o n , it m u s t be s t a t e d tha t, r e g a r d l e s s o f h o w M r . L a n n o n ’s t h e o r i e s a r e v ie w e d , th e f a c t r e m a i n s th a t if e t a m o n a c t u a l l y d o e s p r o d u c e c o m ­ pl et e r e l a x a t i o n o f the a n t a g o n i s t s in po li o m y e l it is , a m o s t u s e f u l w e a p o n wil l h a v e b e e n m a d e a v a i la b le in d e a l i n g w i t h th e e a r l y p a i n f u l s t a g e s o f th e d i s ea s e . O f p a r t i c u l a r i n t e r e s t to p h y s i o t h e r a p i s t s is th e f a c t th a t use o f th e d r u g w i ll e n a b l e e ff ic ie nt a n d p r o ­ g r e s s i v e p h y s i o t h e r a p y a n d r e - e d u c a t i o n to be i n s ti tu te d at the e a r l i e s t p o s s i b le m o m e n t. It is u n d e r s t o o d th at M r . L a n n o n is to pu b li s h a m o r e c o m p r e h e n s i v e r e p o r t in the n e a r fu tu re . THE POLIOMYELITIS RESEARCH FOUNDATION Chairm an : M r s . E . G o r d o n V ice -C h a irm a n : M r . J . G. M e r k i n N ational O rga n isin g Sec. : M r . R . G . S u t h e r l a n d H ead quarters : 14, A s h e r ’ s B u i l d i n g s , J o u b e r t S t r e e t , J o h a n n e s b u r g . P .O . B o x 2325. T eleph on e N o . 33-0438. T e l. A d d r e s s : “ E P I D E M I C .” A l l c o r r e s p o n d e n c e m u s t . b e a d d r e s s e d to the S e c r e t a r y . In r e c e n t m o n t h s a n a t i o n - w i d e o r g a n i s a t i o n ha s b e e n f o r m e d u n d e r th e ti tl e o f th e P o l i o m y e l i t i s R e s e a r c h F o u n d a t i o n . H e a d q u a r t e r s o f th e N a t i o n a l C o m m i t t e e o f th e F o u n d a t i o n is in J o h a n n e s b u r g , a n d a l r e a d y local c o m m i t t e e s h a v e be en f o r m e d in m a n y o f the p r i n c ip le c e n t r e s o f the U n io n . W h i l e this b o d y w i ll b e p r i m a r i l j ' c o n c e r n e d w i t h ) r e s e a r c h , it is felt th a t it d e s e r v e s th e i n t e r e s t and s u p p o r t o f p h y s i o t h e r a p i s t s . W e t h e r e f o r e r e c o m m e n d it to all, an d e s p e c i a l l y to t h o s e w h o h a v e o c c a s io n to dea l w i t h the v ic t i m s o f p o li o m y e l it is in the n o r m a l c o u r s e o f th e ir w o r k . T h e N a t i o n a l O r g a n i s i n g S e c r e t a r y o f the F o u n d a ­ tion ■ h a s s u p p li e d th e f o l l o w i n g e x p l a n a t o r y a r t i c l e w h i c h n o t o n l y d e a ls w i t h its a i m s b u t al so po in ts out a s u g g e s t e d m e a n s f o r o r g a n i s i n g loc al c o m m it t e e s . E p i d e m i c s o f p o li o m y e l it is a r e o c c u r r i n g w i t h i n ­ c r e a s i n g s e v e r i t y in E u r o p e , A m e r i c a a n d A s i a . T h e U n i o n o f S o u t h A f r i c a h a d its f i r s t e p i d e m ic as r e c e n t l y a s 1944-45, f o ll o w e d b y a se co nd , t h e n a t h ir d c o n s i d e r a b l y m o r e s e v e r e , in th e s u m m e r j u s t past. I t is v i r t u a l l y c e r t a i n t h a t u n l e s s p r e v e n t i v e m e a s u r e s c a n b e i n s t i t u t e d w e s ha ll h a v e a s e r i e s of e p i d e m ic s o f i n c r e a s i n g s e v e r i t y a s ha s o c c u r r e d in o t h e r c o u n t r ie s . P o l i o m y e l i t i s h a s b e c o m e th e m o s t s e r i o u s o f the e p i d e m ic s t h r e a t e n i n g h u m a n it y . U n l i k e th e o t h e r m a j o r e p i d e m ic d i s e a s e s , m e d i c a l s c i e n c e h a s no t y e t R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )